Between deductibles, copays, provider networks, and prescription coverage, health plans can feel confusing. It’s easy to assume something is covered only to find out later that it isn’t or miss out on benefits you didn’t even realize you had access to. The good news is that checking your coverage doesn’t have to be overwhelming. With a few simple steps, you can better understand your plan and feel more confident making healthcare decisions.
How to check health insurance coverage
Understanding your health insurance coverage can help you estimate costs, find in-network care, and make the most of the benefits available to you. While every plan is different, there are a few simple ways to find the information you need.
For Mass General Brigham members, checking your covered healthcare services can be made easier with these steps:
1. Log into the Member Portal
When you log into the Member Portal, you’ll see a summary of your health insurance information, including your name, your plan name, your member ID number, and your enrollment effective date.
You should also see options for finding doctors and care, coverage and benefits, cost and claims, forms and documents, and information about your account.
2. Review your plan benefits
Locate the Forms & Documents tab and then expand the list. You should see an option called Plan Documents. Click on that.
Under Plan Documents, you’ll find your Summary of Benefits and Coverage which is a general description of your coverage, your Schedule of Benefits which goes over what your plan covers and what it costs, your Member Handbook, and more.
3. Use our provider search tool
If you want to find out whether a particular doctor is in network with your plan, locate the Find Doctors & Care tab at the top of the Member Portal. Expand the list and select Find Provider. From there, you’ll be taken to our provider search tool.
Within the provider search tool, you can search by people, places, medical specialties, or procedures. Once you find your doctor, you’ll be able to see provider highlights that include their name, business address, whether they’re in network, what tier they’re in, and whether they’re accepting new patients.
4. Contact MGBHP Customer Service
Though you should be able to answer most common questions about coverage between your Schedule of Benefits and the provider search tool, you can contact MGBHP Customer Service if you have additional questions.
You can contact Customer Service at the number on the back of your member ID card or by calling 866-414-5533 (TTY: 711) Monday through Friday from 8 a.m. to 6 p.m. and on Thursdays from 8 a.m. to 8 p.m. You can also reach out via email.
Understanding your health insurance coverage can take some time, but it can make a big difference when it comes to managing your care and avoiding unexpected costs.
